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POC NAT Acceptability Survey
[NCHHSTP] The GAIN (Greater Access and Impact with NAT) Study: Improving HIV Diagnosis, Linkage to Care, and Prevention Services with HIV Point-of-Care Nucleic Acid Tests (NATs)
OMB: 0920-1357
IC ID: 247954
OMB.report
HHS/CDC
OMB 0920-1357
ICR 202311-0920-002
IC 247954
( )
Documents and Forms
Document Name
Document Type
Form 0920-1357
POC NAT Acceptability Survey
Form and Instruction
0920-1357 NAT Acceptability Survey (SCREENSHOTS)
Att 12_POC NAT acceptability survey_screenshots_10-28-21.pdf
Form and Instruction
0920-1357 NAT Acceptability Survey (SCREENSHOTS)
Att 12_POC NAT acceptability survey_screenshots_10-28-21.pdf
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
POC NAT Acceptability Survey
Agency IC Tracking Number:
0920-1357-24AQ
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-1357
NAT Acceptability Survey (SCREENSHOTS)
Att 12_POC NAT acceptability survey_screenshots_10-28-21.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
500
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
500
0
383
0
0
117
Annual IC Time Burden (Hours)
167
0
128
0
0
39
Annual IC Cost Burden (Dollars)
3,190
0
2,444
0
0
746
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.